British Columbia’s top court has upheld a decision to revoke almost a decade of medicare coverage for an immigrant couple, confirming in a rare judgment that provinces have every right to deny health funding to people who spend too much time living abroad.

B.C., like most provinces, requires that patients spend at least six months annually in the jurisdiction to benefit from medicare, and alleged Sayed Geissah and Souad Khalaf had lived most of the past several years in the Middle East.

The pair had argued that the Canadian citizenship they obtained gave them the right to reside wherever they wanted, and that B.C.’s medicare agency could not force them to live in Canada when it was too expensive for them to do so.

The Court of Appeal said in a judgment this month that the province had acted legally when it retroactively stripped them of coverage for a nine-year period.

It may be the first time the courts have ruled on medicare residency laws, and has potentially broad ramifications given that millions of Canadians live in other countries, said Sergio Karas, a Toronto immigration lawyer. People residing most of the year outside Canada usually do not pay income taxes here.

“Winters in Canada are pretty harsh, we all know that, and cost of living is cheaper abroad,” he said.“Unless there is some mechanism for enforcement, the damage could be substantial for the provincial coffers.”

The case could give other provinces added impetus to enforce residency laws in similar situations, said Mr. Karas.

Mr. Geissah and Ms. Khalaf could not be reached for comment.

Kristy Anderson, a spokeswoman for the B.C. Health Ministry, said she could not comment directly on the case for privacy reasons, but confirmed the department periodically carries out “residency reviews” to ensure people qualify for coverage.

“With the current pressures facing our health-care system we need to be sure our resources are focused on eligible residents,” she said.

The family immigrated to Canada in 1994, became eligible for medicare three months later, and some time after that became citizens, according to the ruling.

Their sons moved about 12 years ago to Egypt, Dubai and Qatar and the parents claimed they spend just six months each year visiting them and their grandchildren.

‘With the current pressures facing our health-care system we need to be sure our resources are focused on eligible residents’

The B.C. Health Ministry launched an investigation in 2011. The couple refused to provide records of their travels, the ruling said, but the department concluded the timing of their health-care claims — with none in 2004 or 2005 and few in the rest of the 2000s — suggested they had not made their home in the province.

British Columbia’s Medical Services Commission ruled they were ineligible for coverage from December 2001 until July 2010, though it has so far declined to seek repayment of health services they received in that period.

Mr. Geissah and Ms. Khalaf asked for a court review of the decision, and then appealed to the high court when the first judge ruled against them.

They made several arguments, including that the claims evidence failed to prove they were not residents, and that they received Old Age Security from the federal government, which showed they were residents.

They also suggested “the citizenship ceremony granted them the right to live anywhere,” and that it was “illegal to force them to reside in Canada when they cannot afford to do so,” said the appeal court ruling, written by Justice David Frankel.

“I find no merits in any of the arguments,” he said.

Meanwhile, B.C. is introducing a new rule in March, allowing people to stay outside the province a total of seven months, for vacation purposes only, and still be eligible for medicare.

Mr. Karas said the court case also highlights the issue of so-called Canadians of convenience, immigrants who obtain citizenship, then end up living much of their lives in their home countries.

The Asia-Pacific Foundation estimated in a 2009 report that 2.8 million Canadian passport-holders live outside Canada, about a million of them in the U.S., and smaller numbers in Hong Kong, the U.K., Taiwan, China and Australia.